Provider Demographics
NPI:1528059045
Name:FAZZONE, HILARY (MD)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:FAZZONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:202 STEVENS AVE
Practice Address - Street 2:MIGNONE MEDICAL EYE CARE PC
Practice Address - City:MT. VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-664-6001
Practice Address - Fax:914-668-0110
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY215120207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02427769Medicaid
H09058Medicare UPIN
NY512B21Medicare PIN